Provider Demographics
NPI:1295986248
Name:STAUDT, MEGAN LYNN (PA)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:LYNN
Last Name:STAUDT
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Gender:F
Credentials:PA
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Mailing Address - Street 1:140 INDUSTRIAL LOOP
Mailing Address - Street 2:SUITE 100
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78624-5456
Mailing Address - Country:US
Mailing Address - Phone:830-990-8651
Mailing Address - Fax:830-990-0852
Practice Address - Street 1:140 INDUSTRIAL LOOP
Practice Address - Street 2:SUITE 100
Practice Address - City:FREDERICKSBURG
Practice Address - State:TX
Practice Address - Zip Code:78624-5456
Practice Address - Country:US
Practice Address - Phone:830-990-8651
Practice Address - Fax:830-990-0852
Is Sole Proprietor?:No
Enumeration Date:2008-10-08
Last Update Date:2013-02-26
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Provider Licenses
StateLicense IDTaxonomies
TXPA05363363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant